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LIBRARY Of CONGRESS. 



UNITED STATES OF AMERICA. 



THEINE 



TREATMENT OF NEURALGIA 



PHYSIOLOGICAL CONTRIBUTION TO THE 
THERAPEUTICS OF PAIN. 



THOMAS J.' MAYS, M. D., 

PROFESSOR OF DISEASES OF THE CHEST IN THE PHILADELPHIA POLYCLINIC; 

MEMBER OF THE PHILADELPHIA COLLEGE OF PHYSICIANS, OF THE 

PHILADELPHIA COUNTY MEDICAL SOCIETY, ETC., ETC. 



If*' 



PHILADELPHIA: 
P. BLAKISTON, SON & CO., 

IOI2 Walnut Street. 
1888. 




1^ 






Copyright, 1888, 
By THOMAS J. MAYS. 



PRESS OF WM F FELL & CO., 

1220-24- SANSOM ST., 

PHILADELPHIA. 



TO 

DR. EDWARD R. MAYER, 

Of Wilkesbarre, Pennsylvania, 

IN APPRECIATION OF HIS EMINENT PROFESSIONAL ABILITY, 

AND IN GRATEFUL REMEMBRANCE OF HIS MANY 

DEEDS OF PERSONAL KINDNESS TO 

THE AUTHOR, 
^])i8 liiih holumt is 3^t5ptctfulb Stiicat^iJ. 



PREFACE. 



This essay on Theine originally appeared in 
the Polyclinic, from September, 1887, to Feb- 
ruary, 1888 ; and in order to give the research 
which has been made of this drug a more per- 
manent place in medical literature, it was 
deemed proper to publish it in a separate little 
volume. 

Herewith I desire to express my warmest 
thanks to those of my medical friends who 
have been kind enough to report to me the 
results which they obtained in the clinical em- 
ployment of theine ; for I feel that the practical 
value which this investigation possesses is chiefly 
due to this part of the contribution. 

T. J. M. 

1829 Spruce Street, Phila., 
March jth, 1888. 



CONTENTS. 



CHAPTER I. 

PAGE 

Introduction — Theine, 9 



CHAPTER n. 
The Physiological Action of Theine, . . . i i 

CHAPTER HI. 

The Special Therapeutic Indications for 
the Use of Theine, -29 

CHAPTER IV. 

Neuralgia, 39 

Appendix, 81 

Index, S;^ 



INTRODUCTION. 



CHAPTER I. 
THEINE 
The tea-plant, from which theine is obtained, 
is a shrub from twenty to thirty feet high, and 
is indigenous to the southern part of Asia, but 
is extensively cultivated in China, Japan, and in 
South America, as well as to a small extent in 
the United States. Its use as a beverage dates 
from a very early period in Chinese history, but 
the Greeks and Romans were ignorant of its 
existence, and it was only introduced into Eu- 
rope about the year 1657. The botanical origin 
of tea is Thea Bohea, T. viridis, T. sinensis, 
and T. assamica, and a few hybrids ; and the 
many varieties of tea in the market are prepared 
by selecting young or old leaves, and subjecting 
them to various processes of treatment. Tea 
B 9 



lO HISTORY OF THEINE 

was probably first used for medicinal purposes. 
It is a common custom of our own day to apply 
tea leaves for the purpose of reducing inflamma- 
tion and allaying pain. 

Theine, to which tea principally owes its vir- 
tues, is an alkaloid, and was first found in the 
leaves of Chinese tea by Oudry, in 1827. This 
discovery was confirmed by Miilder and Jobst, 
in 1838, who believed it to be identical with 
caffeine and guaranine. Its chemical formula 
is CgHioN^Og, and it is known as trimethyl- 
xanthine. It occurs in snow-white, needle- 
like crystals, is almost tasteless, but produces a 
slight tingling on the end of the tongue, which 
is immediately followed by a temporary local 
anaesthesia. It is soluble in fifty parts of cold, 
but more soluble in warm water. 



CHAPTER II. 
THE PHYSIOLOGICAL ACTION OF THEINE 

My first experiments with theine were made 
in the spring and summer of 1885, and were 
pubhshed in the Therapeutic Gazette for Sep- 
tember, 1885, under the title of The Physiologi- 
cal and Therapeutic Actioji of Caffeine, Theine, 
and Guaranine. At this time I was ignorant of 
the fact that theine, caffeine, and guaranine 
were manufactured indiscriminately from coffee, 
tea, kola nut, Paraguay tea and guarana ; and 
that they were all sold out of the same bottle 
and labeled according to the demands of the 
trade ; but I supposed that I was using theine 
made from tea leaves, and caffeine from coffee 
beans. Inquiry, however, soon undeceived 
me afid demonstrated very positively that nearly 
all of that which is sold under the name of caf- 
feine at present is not caffeine at all, but theine, 
II 



12 PHYSIOLOGICAL ACTION 

since it so happens that it is cheaper to manu- 
facture the alkaloid out of tea leaves than from 
any of the other raw materials. Moreover, it 
was further found that very little, if any, theine 
or caffeine is manufactured in this country, and 
that these agents are principally imported from 
Europe. 

Of course, under these circumstances, it was 
quite evident that the article which I used for 
theine must have emanated from tea, but on 
account of the uncertain nature of that which I 
used for caffeine I determined to review all my 
previous work on this subject. That I used two 
different agents was quite certain, for I could not 
have obtained the varying results in my experi- 
ments which I did if they had been alike in 
composition. Therefore Mr. William C. Harris, 
then with Messrs. Henry C. Blair's Sons, kindly 
undertook to manufacture both alkaloids for 
me from tea and coffee, respectively, and 
quite recently I also received the same alkaloids, 
made from the same sources, from Merck, of 



OF THEINE 13 



Darmstadt, who, since my second series of ex- 
periments, has informed me that he will in the 
future manufacture these alkaloids separately — 
hence in ordering from him it is necessary to 
specify the alkaloid which is wanted. I fully 
reviewed my former work, and the net result 
confirms the conclusions drawn from the first 
series, and I have even found reason for believ- 
ing that the difference between the action of the 
two alkaloids in regard to sensation is greater 
than my earlier experiments indicated. 

The gross effects of tea and coffee on the 
animal economy have always been regarded 
as dissimilar, but their alkaloids have, until 
quite recently, been universally considered 
identical in their action. The supposed iden- 
tity of action of the two latter agents can only 
be explained on the score that, after once 
having been shown that they are chemically 
alike, the assumption naturally followed that 
they must also be alike in their physiological 
action. This view of their supposed identity 



14 PHYSIOLOGICAL ACTION 

of action has also been encouraged by Aubert, 
Albers, Amory, Bennett, McKendrick, Burnett 
and others who investigated the drugs experi- 
mentally, although Leven, as far back as 1868, 
showed that theine produced convulsions in 
frogs while caffeine did not ; and that the 
lethal dose of theine was larger than that 
of caffeine. One important reason why the 
results of Leven differ so materially from those 
derived by others lies in the fact that he used 
the genuine alkaloids produced separately 
from tea and coffee, which does not appear 
to have been the case with the other experi- 
menters. Moreover, in view of the fact that 
the effects of theine and caffeine were believed 
to be the same, it is very difficult to obtain 
evidence as to the action of either agent. Toxi- 
cologically, we know more about caffeine than 
we do about theine, for, since coffee is much 
more powerful than tea, it has occasionally 
been employed for criminal purposes. 

A detailed account of the large number of 



OF THEINE 15 



experiments which I made with these agents 
will not be given here, since they would swell 
this little work to undue dimensions ; but their 
condensed results, which appear below, demon- 
strate that, while the actions of theine and 
caffeine agree in many respects, they also dis- 
agree in some important particulars. They 
both first affect the anterior extremities of 
frogs, and both diminish respiration and cause 
hyperaesthesia during the latter stage of the 
poisoning process, although the supersensitive- 
ness is much more marked in theine than in 
caffeine. They differ in the following respects : 
Theine principally affects sensation, while caf- 
feine does not ; theine produces spontaneous 
spasms and convulsions, while caffeine does 
not until very late in the stage of poisoning ; 
theine impairs the nasal reflex early in the 
poisoning process, while caffeine does not, if at 
all, until the very last stage ; the lethal dose of 
theine is larger than that of caffeine. 

The differences in the action of these two 



l6 PHYSIOLOGICAL ACTION 

agents as here indicated will, I think, be suffi- 
cient to convince even the most skeptical that 
theine and caffeine can no longer be regarded 
as identical, so far as their physiological action 
on the frog is concerned. In order to show to 
myself, as well as to others, that there is a de- 
cided difference between the two preparations, 
and that I did not practice any unconscious 
self-deception, I frequently tested the contents 
of two numbered vials, one of which contained 
theine and the other caffeine, but which were 
only known to me by their numbers, and could, 
without difficulty, always designate the true 
nature of each specimen after testing its action 
on the frog. This is, certainly, a crucial ex- 
periment which demonstrates very clearly that 
the toxicological tests of experimental physi- 
ology are more accurate and delicate than those 
of physics and chemistry combined. 

The argument which has been advanced 
against my deductions that the theine and 
caffeine employed by me were probably not 



OF THEINE 17 



chemically pure, must, I think, fall to the 
ground, when it is taken into consideration that 
precisely identical results were obtained from 
two separate manufactures of both alkaloids by 
Merck, of Darmstadt, against neither of which 
the charge of impurity can be brought. In the 
early part of my experimental review I did use 
preparations of both which were not altogether 
free from the coloring matter of the raw ma- 
terial, but they gave rise to the same differences 
as those which were brought out subsequently 
by the purer specimens. However, if the ob- 
jection of impurity be still urged, it devolves 
on those who make it to manufacture such 
specimens of both alkaloids which will satisfy 
their ideal of purity, and have them subjected 
to a proper test for the purpose of finding out 
whether they fail to give a differential physio- 
logical reaction. 

The power of theine to produce such decided 
and complete sensory paralysis in the lower 
animals led me to test its physiological prop- 



PHYSIOLOGICAL ACTION 



erties on the healthy human being, and, with 
this end in view, I introduced moderate, or 
probably small, doses of the drug hypoderm- 
ically in a nuijiber of instances, and noted the 
results. 

In the main, there was a general agreement 
in the symptoms which developed, and hence 
only one case, typical of the rest, will be given 
here. The drug was injected into the left fore- 
arm of an adult in good health, whose same arm, 
however, was fatigued by carrying a satchel to 
the railroad station on the previous morning. 
1.40 p. M. Injected i grain of theine in left fore- 
arm, near elbow. 

1.42. Fatigue in arm gone. 

1.43. Diminution of sensibility in left forearm, 
especially around seat of injection. 

1.46. Diminished sensibility extends as far as 
hand. 

1.48. Some burning at seat of injection. 

1.49. Touch impaired in tips of fingers of same 
hand. 



OF THEINE 19 



1.5 1. Tingling in wrist and fingers. 

1.52. No discernible influence on pupil. 

1.54. Voluntary motion of arm and hand unim- 
paired. 

1.56. Burning around seat of puncture gone. 

2.02. No impairment of sensation above the 
elbow. 

2.03. Slight shooting pains along the posterior 
part of left arm above elbow. 

2.06. Sensibility of finger tips impaired. 

2.08. Finger tips very dull. 

2.1 1. In playing the piano, can move the fin- 
gers of left hand as well as those of right. 

2.13. Mind perfectly clear. 

2.30. Sensibility absolutely gone around seat of 
injection. 

2.34. Finger and left hand feel as if " asleep." 

2.44. Left hand numb. 

2.55. No difference in temperature between 
two hands. 

3.01. Finger tips very numb. 
3.06. Feels somewhat sleepy. 



20 PHYSIOLOGICAL ACTION 

5.30. Sensibility still impaired, especially in fin- 
ger tips. Arm above elbow uninfluenced. 
6.40. Sensation more normal in forearm. Fin- 
ger tips still feel numb. 
8.00. Sensation entirely restored. Some red- 
ness and tenderness around seat of punc- 
ture. 
The physiological action of theine on man, as 
brought out in this as well as in a number of other 
observations under my care, may be summed 
up as follows : Dose from one-fifth to half a 
grain. Numbness of arm and hand below seat 
of injection — " a feeling as if the hand had 
been steeped in a solution of carbolic acid," as 
one of the subjects of experimentation expressed 
it. A feeling of coldness and an occasional 
disturbance of temperature in the member under 
its influence. A slight reduction in the pulse 
rate, and no intoxication of the brain. No im- 
pairment of motion. The anaesthesia shows 
itself in a very few minutes, and is much more 
marked in some individuals than in others. A 



OF THEINE 21 



relief to the feeling of fatigue. The tempera- 
ture disturbance was not regular. Out of four 
cases in which the temperature was taken, it 
showed no difference in one, and in another 
one the uninjected hand was slightly higher 
(0.4° Fahr.) in temperature than the injected 
one. In two there was quite a marked fall in 
temperature — one 0.8° Fahr. and the other 1.2° 
Fahr. lower in the hand of the injected than in 
that of the uninjected arm. And, strange to 
say, the hand which showed the greatest de- 
pression in temperature experienced the least 
degree of anaesthesia. A certain feeling of 
coldness always accompanies the numbness 
produced by theine, yet, in my earlier observa- 
tions, I repeatedly failed to detect any ther- 
mometric differences. 

Dr. C. H. Castle, of Cincinnati, Ohio, was in- 
duced to test the action of theine by the appear- 
ance of my first article on this subject.^ The 

* The Therapeutic Action of Theine; a New Analgesic. 
Phila. Medical News ^ December 12th, 1885. 



22 PHYSIOLOGICAL ACTION 

results of his experiments, which were both of a 
physiological and chemical nature, were read 
before the Cincinnati Medical Society, and pub- 
lished in The Cincinnati Lancet and Clinic for 
February 6th, 1886, and since they were made 
with pure theine, extracted by his own chemist, 
and because they add some hitherto unobserved 
features in the action of the drug, they are ex- 
tremely interesting and instructive. He made, 
in all, three physiological experiments on him- 
self, of which he says : — 

" The first time I injected one-sixth of a grain 
into my left forearm, immediately below the 
flexure of the elbow joint. I will not weary you 
with the details of the observations as made at 
intervals of a few minutes. The noticeable 
effect was remarkably rapid. An angry blush 
and swelling spread from the point of injection, 
but what looked like a most delicately ten- 
der spot was singularly devoid of sensation. 
It was not, nor did it become, totally 
anaesthetic, but in what appeared to be 



OF THEINE 



an inflamed area of sensibility was markedly 
dulled. Presently a numbness, such as we feel 
when a member is beginning to 'go to sleep,' 
from pressure upon its supplying nerves, stole 
over my wrist and hand. Little tinglings, 
scarcely noticeable had not one been on the 
watch for strange manifestations, came and 
went in various places. At no time was motility 
impaired. The temperature of the left hand, 
and I beg to call your attention to this point, 
was markedly lowered. The effects of the 
injection lasted about two hours. 

" The second injection was made under 
somewhat different circumstances. I had rather 
severely bruised my right hand, and the pain 
on pressure over the metacarpal bone was quite 
severe. I therefore injected one-third grain of 
theine subcutaneously over the ulnar nerve 
just below the elbow. 

** The same phenomena were noticed as in 
the first use of the alkaloid — sensibility around 
the injection was markedly diminished, lower 



24 PHYSIOLOGICAL ACTION 

down the forearm and in the wrist and hand 
less markedly so ; the right hand lost as much 
in temperature as had the left hand previously, 
but I am compelled to say that I was disap- 
pointed in the analgesic effect that I had 
expected. The extreme sensibility was dulled, 
to be sure, and my hand no longer hurt when 
I put it into my overcoat pocket, as it had be- 
fore, but any deep pressure instantly informed 
me that the nerves about the joint still resented 
the impact of a foreign body with the surface. 

" The third observation was made again 
upon the left arm ; this time one-half of a grain 
was used, and though an accident, perhaps, 
somewhat marred the experiment, some points 
were brought out more prominently. The in- 
jection, made for me by a friend, was a deep 
one — intermuscular — and the withdrawal of the 
needle was followed by a slight hemorrhage, 
sufficient to raise a conical subcutaneous tumor 
of a diameter of a one-cent piece. Instantly 
there was a deep-seated pain, probably due, I 



OF THEINE 25 



thought, to extravasation from the wounded 
vessels into the intermuscular planes. Full ex- 
tension was impossible ; partial extension very 
painful ; the painful seats being deeply under 
the point of injection and the dorsal aspect of 
the metacarpo-phalangeal points. 

" As in former observations, sensibility was 
affected almost immediately, and in three 
minutes the left hand was blanched and al- 
most cold to the touch. My pulse was always 
full, strong, and but slightly more frequent 
than normal. Very soon peculiar constitutional 
disturbances appeared, and not entirely like 
those described in the standard works on ma- 
teria medica. I was excited and talkative, and 
so rapidly did I talk that I would soon exhaust 
a subject broached by others, and endeavor to 
introduce some natural descendant of the idea 
as a topic of conversation, apparently so far 
ahead of its proper sequence in a well-ordered 
train of thought as to appear like an interrup- 
tion with an irrelevant subject. Failing to 



26 PHYSIOLOGICAL ACTION 

gain a hearing, as I frequently did, I would in- 
dulge in snatches of song or broken ejaculations 
which had a world of meaning in them then, 
but which, as I look back upon them now, 
seem utterly absurd. 

"Alternating with states of great bodily ac- 
tivity were spells almost of a fainting character. 
These were seven or eight in number, and 
beginning soon after the injection, gradually 
ceased after the lapse of six or seven hours." 

This vivid description of the effects of theine, 
as Dr. Castle observed them on himself, is 
very instructive, and in some respects new. 
The psychic disturbance which he experienced 
I have never observed, although I have admin- 
istered five times the quantity he employed ; 
and the only way in which I can account for his 
cerebral intoxication is on the score that the deep 
injections which he practiced chanced to in- 
troduce the theine directly into a blood vessel, 
and it was at once carried to the brain and pro- 
duced the hallucinations as described. This 



OF THEINE 27 



is all the more probable because the central 
disturbance manifested itself directly after the 
injection, which, ordinarily, should not have 
appeared until in a later stage of the poisoning 
process. 

From these experiments, and from those 
which were made on the frog, I think the follow- 
ing conclusions may be legitimately drawn 
concerning the physiological action of theine on 
man : — 

1. It has a special affinity for the nerves of 

sensation. 

2. It produces anaesthesia when administered 

subcutaneously. 

3. Its anaesthetic action is confined below the 

seat of its injection, /. <?., its influence ex- 
tends from the centre to the periphery, 
and not in the opposite direction. 



CHAPTER III. 

THE SPECIAL THERAPEUTIC INDICATIONS FOR 
THE USE OF THEINE 

From its physiological action it is quite ob- 
vious that in theine we possess an agent which 
has the power of paralyzing sensation without 
affecting motion, and that it does this with a 
great degree of certainty and without any appre- 
ciable injury to any part of the body, even when 
administered in large doses. It now remains 
for clinical medicine to demonstrate and to 
establish how far this analgesic property can 
be utilized, and with this purpose in view the 
greater portion of the following pages will be 
devoted to the task of pointing out the special 
pathological conditions and to that of the cita- 
tion of cases in which the drug is indicated. 

In order to obtain the full effect of theine, it 
is not necessary to inject it deeper than imme- 
diately beneath the skin. Of deep injections I 
29 



30 THERAPEUTIC INDICATIONS 

am not able to speak intelligently, since I was 
always satisfied with the results which are 
derived from superficial injections. Dr. Castle, 
in the article already referred to, relates his own 
personal experience with one deep injection, in 
which the drug certainly exerted a marked 
influence on the brain, owing, probably as has 
already been stated, to the fact that the whole 
dose found direct entrance into the circulation, 
and was at once carried to the great nerve 
centres. 

Again, theine, as a rule, is surprisingly 
prompt in exerting its analgesic action. I have, 
on a large number of occasions, witnessed pa- 
tients who had too much pain to move an 
arm, or who were too stiff to stand erect, swing 
their arms and straighten their bodies in less 
than five minutes after its introduction. It is 
not always so prompt, but this is probably due 
to the smallness of the dose. I have seen cases 
where no benefit had been derived from one- 
third of a grain, which, on the dose being 



FOR THEINE 3 1 



doubled, improved at once. Therefore, when 
a single dose fails to act favorably, it is always 
advisable to increase, even if this has to be 
done to a large extent. I have repeatedly 
injected as much as two and one-half grains 
without experiencing anything except the 
best results, I would not hesitate to go 
even beyond this limit. To one patient who 
was suffering from the most intense neuralgia 
of both lumbo-sacral and left cervico-brachial 
plexuses, which was accompanied by sleepless- 
ness, spasm of the muscles of both legs and of 
those of the left arm, I gave two and one -half 
grains of theine subcutaneouslyin four different 
localities along the spine, with instantaneous 
relief to the pain, and the induction of sleep 
during the following night. This amount was 
injected daily for twenty-one days in succession, 
at the end of which time he was almost entirely 
free from pain, improved in appetite and in 
sleep, and felt better in every way. In another 
case of locomotor ataxia, I injected three grains 



32 THERAPEUTIC INDICATIONS 

of theine in different spots along the spine 
every other day, chiefly for the purpose of 
relieving the pain and contractions in the ex- 
tremities, as well as the constriction around the 
base of the chest. It removed all these diffi- 
culties at once, and made the patient feel more 
comfortable than before. Another feature which 
recommends theine to favor is its prolonged 
influence. After pain has once been relieved 
by it, it is very rare to find the same returning 
inside of ten or twelve hours, and oftener 
not until in twenty-four hours, and then, in all 
probability, not in its original intensity. I am 
referring now to obstinate cases of pain. Where 
the pain is more unstable, it is not rare to find 
that one or two injections relieve it perma- 
nently. 

No prolonged irritation and no inflammation 
have ever been produced during my experience 
at the seat of its injection. It gives rise to some 
burning at first, which disappears in the course 
of a very few minutes, and is replaced by a 



FOR THEINE 33 



marked area of anaesthesia. Most of the burn- 
ing is undoubtedly due to the comparatively 
large amount of water which is necessary to 
dissolve a drug of a solubility as low as that of 
theine. When it is prepared with benzoate of 
soda its solubility is markedly increased, and* I 
have therefore used it for more than a year 
according to the following formula : — * 

R. Theine, 

Sodium benzoate, aa ^j 

Sodium chloride, gr. viij 

Distilled water, flgj. M. 

SiG. — For hypodermatic use. Six minims equal 
one-half grain of theine. 

Finally, in regard to the employment of a 
particular kind of theine, I would say that every- 
thing which at present falls within the commer- 
cial description of both drugs is principally 
made up of theine ; hence, very good clinical 
results are obtained from that which is found in 

* Theine tablets for hypodermic use are now manufactured by- 
Mr. J, A. Kyner, pharmacist of the Phila. Polyclinic. Also 
by Mr. William C. Harris, 23CI and Spruce Sts., Philadelphia, 



34 THERAPEUTIC INDICATIONS 

the market, although it is very obvious, from 
my experimental deductions in regard to the 
differential action of theine and caffeine, that 
the best results are obtained from the genuine 
article, which is now manufactured and fur- 
nished by Merck, of Darmstadt, Germany, and 
which I altogether employ at the present time. 
In order to avoid annoyance and disappoint- 
ment, it is highly important to constantly bear 
in mind the pathological conditions which only 
are amenable to the influence of theine. It 
must be borne in mind, first of all, that its 
function is solely that of pain-relieving ; and 
while it performs this office to perfect satisfac- 
tion, it also fails to give permanent relief to 
obstinate and protracted pain, unless it is aided 
by remedies which tend to improve the nutri- 
tive state of the affected nerves, or which are 
capable of removing the diatheses upon which 
the painful affections depend. A neglect of 
this simple rule frequently led to failures in my 
earlier employment of the drug. Therefore the 



FOR THEINE 35 



burden of what follows in this essay will be 
devoted to a consideration of the relation be- 
tween the action of theine and neuralgia, as 
well as that between its action and other kinds 
of pain which are generally associated with 
various constitutional conditions, like malaria, 
anaemia, simple chronic rheumatism, chronic 
gonorrhceal rheumatism, gout, etc. ; and in 
connection with the theine treatment, the im- 
portance of appropriate auxiliary medication 
in each special condition will be fully discussed. 

THE DIFFERENTIAL ACTION BETWEEN THEINE 
AND MORPHINE. 

Morphine enjoys the distinction of being the 
favorite analgesic of the medical profession, and 
there can be no doubt that it fairly merits this 
position. The physiological action of morphine, 
however, differs widely from that of theine. It 
produces its analgesia by primarily affecting 
the cerebral centres, although the experiments 
of Eulenberg, Falk and others show that it 
causes a certain degree of local anaesthesia at 



36 THERAPEUTIC INDICATIONS 

the seat of injection. But in order to manifest its 
characteristic action, which is central and not 
local, it must be carried to the cerebrum by 
the circulation, and make its impress there, 
while theine, as we have seen, has a local action, 
which is entirely independent of the great nerve 
centres. The peripheral action of theine seems 
to be confined altogether below the seat of its 
injection, although there can be no doubt of its 
general absorption by the blood and of its 
distribution throughout the whole body. The 
feelings of patients and of persons on whom I 
have made physiological experiments invari- 
ably attest the fact that the brain is exempt from 
any narcotic impression, and that its perceptible 
action is wholly confined to a point below its 
introduction, in which region they feel a sense 
of tingling and of numbness. This localized 
influence brings out one of the great therapeutic 
advantages which theine possesses over mor- 
phine and over all other agents of this class. 
By operating only on the peripheral portion of 



FOR THEINE yj 



the trunk of a nerve and of its ramifications, it 
leaves the higher nerve centres intact, and hence 
does not bring about the undesirable central 
intoxication which almost always follows a full 
dose of morphine. 

It is very clear, then, that the spheres of action 
of morphine and of theine are entirely different, 
and that each one must be prescribed in suit- 
able conditions, and in order to achieve this 
practical end the following rule may be 
suggested : When it is necessary to narcotize 
the centres of innervation in order to relieve a 
given pain, then morphine is indicated ; but 
when it is not necessary to do this, then theine 
will accomplish the work safer, better and more 
promptly than morphine. On general principles 
it may, therefore, be stated, that morphine 
gives the best results in acute pain, while theine 
is most beneficial in chronic affections of the 
sensory nerves. 



CHAPTER IV. 

NEURALGIA 

Neuralgia is preeminently a painful disease. 
It is, in most instances, a unilateral and an 
intermittent affection, and manifests itself in 
tender spots, which mark the superficial exit of 
the affected nerves. It is generally looked upon 
as a functional disease ; but there can be no 
doubt that the condition which answers to the 
symptom of pain is one in which there is a 
morbid constitutional change of the nerve 
giving rise to it, although there is no evidence 
of any such change to our unaided senses. 
Furthermore, there can be no doubt that in all 
cases of neuralgia either the general or local 
condition of the sufferer at the beginning and 
during the attack is one of anemia, depression 
and debility. The affected nerve is impaired in 
its nutrition, and hence its vitality sinks below 
that standard which constitutes 7ierve health. 

38 



NEURALGIA 39 



The subjective expression of this exhausted 
state is one of pain, which Valleix defines as 
the cry of a hungry nerve. 

Neuralgia is generally of malarial and some- 
times of rheumatic origin, but is also frequently 
associated with certain periods and conditions 
of life in which the malarial and rheumatic 
elements may be entirely wanting. Thus, it 
occurs in the middle period of life, when the 
body is most exposed to severe and protracted 
labor, to child-bearing, etc., as well as during the 
period of bodily decay, when senile degenera- 
tions are prone to set in. Then, again, it also 
manifests itself in states of malnutrition, anae- 
mia, etc. Topographically, neuralgia may be 
divided into several local varieties, the chief of 
which are the sciatic, crural, intercostal, dorsal, 
cervico-brachial, cervico-occipital and trigem- 
inal — given here, probably, in the order of 
frequency with which they meet the eye of the 
practitioner. Cases of each of the above-named 
varieties, which were treated with theine, will 



40 SCIATICA 

be given in their appropriate places, as well as 
their additional treatment.^ 

SCIATICA. 

Case i. — Mrs. A.; aged 49 years; came under 
my care May 2d, 1885, when she had constant 
pain in right leg from hip to foot, ever since the 
preceding Christmas. The pain followed the 
course of the nerves of the leg, and, of course, 
was very much aggravated by walking. The 
leg was considerably atrophied and was weak 
and uncertain in its gait. Her appetite was 
poor and bowels irregular, and she passed 
whole nights without sleep, on account of pain. 



* The additional treatment, unless otherwise stated, fre- 
quently consisted in the administration of two mixtures, which I 
found very useful, the formulae for which will be reproduced 
here ; and in order to save space and repetition, they will be re- 
ferred to in the following pages as the quinine and ammonia 
and the sodium salicylate mixtures, respectively : — 



^. Quininae sulph., 




^ 


. Sodae salicyl.. 






Ammonise mur., 


aa 


5j 


Potass, acetas, 






Tinct. ferri chlor., 




fSss 


Potass, bicarb., 


aa 


Si 


Chloroform!, 




gtt. X 


Tinct. digitalis, 




foiij 


Svr, simplici, 




fSiiss 


Aquae menth. pip. 


,,q.s 


.fSiv 


Aquae menth. pip. 


,q.s 


. fBiv. ] 


M. SiG. A teaspoonful 


every 


M SiG. A teaspoonful 


every 


4 hours. 






4 hours. 













SCIATICA 41 



She was anaemic, and had been treated with 
iron, quinine, ammonia, sodium sahcylate, 
potassium iodide, atropine, morphine, poul- 
tices, blisters, etc., without avail, until the fol- 
lowing 1 8th of July, when I injected one-fifth 
grain of theine into the calf of her leg. The 
pain ceased in less than five minutes, and never 
returned in its original force. In half an hour 
her heel and foot began to feel numb and 
insensible, which lasted for about twelve hours, 
but her mind was perfectly free from its influ- 
ence. She experienced no headache or drowsi- 
ness. 

July 20th. Pain in whole leg better since last 
injection, but has not entirely disappeared from 
the thigh, so I introduced one-fifth grain into 
the latter region. 

28th. Leg altogether free from pain, but still 
complains of some in foot ; otherwise she is 
improving. Injected one-fifth grain over instep. 

Sept. 6th. Feels better. Slight pain around 
ankle joint. Injected one-tenth grain at this 



42 SCIATICA 



point. This was the last injection she received, 
and she made an uninterrupted recovery. 

Case ii. — B.; aged 50; carpenter; was first 
seen April 3d, 1886, when he complained of a 
severe pain for nearly two years in lumbar 
region, radiating down both legs. He is stiff in 
both legs and in the back, and rises from a 
chair with great difficulty. He had malaria, 
but gives no specific or rheumatic history. In- 
jected half-grain doses of theine on each side of 
the sacrum, and two doses of similar strength 
near the trochanters on both sides. He said it 
relieved the pain and stiffness at once, and that 
he was as able as ever to get up from a chair. 

April 6th. Says he is better, but still has some 
pain. Repeated the injections and internally 
gave him the quinine and ammonia mixture. 

April loth. Pain nearly all out of back, legs feel 
somewhat stiff. Two injections near the trochan- 
ters on both sides. Same internal treatment. 
This patient continued to improve, and was 
entirely well by end of same month. 



SCIATICA 43 



Case hi. — S. M.; aged 49 ; came under my 
treatment March 25th, 1886, when she com- 
plained of pain in right hip, which extended 
down the Hmb of the same side. Impairment 
of motion and stiffness in same leg. Had 
malaria. At her first visit gave her quinine 
and ammonia mixture only. The next day, the 
26th, she returned and reported that the pain 
was no better, and that it extended as far as the 
ankle joint. She said that she had a feeling as 
if a lump of ice were lying against her foot all 
the time. Injected half a grain of theine in 
right hip near the great trochanter. 

April 1st. Some improvement — walks much 
better. Another injection of theine and same 
internal treatment. 

April 3d. Pain all gone except below the knee ; 
another injection. 

April 4th. Coldness in foot has disappeared 
and is almost entirely free from pain. Another 
injection. She continued to improve. 



44 SCIATICA 

Case iv. — C. P. ; aged 48 ; had pain in right 
hip joint on April 20th, 1886, which followed 
the course of the sciatic nerve on same side. 
Stoops with great difficulty. Had rheumatism. 
Injected half a grain of theine over painful spot 
in hip joint, which relieved him at once. Could 
stoop without pain after injection. Never saw 
him again. 

Case v. — L. M.; aged 60; came to me, April 
22d, 1886, complaining of severe pain in sacral 
region, which radiated down both extremities as 
far as the knees. Injected half a grain on each 
side of sacrum, and she expressed herself much 
relieved immediately after the injection. Inter- 
nally, she received the quinine and ammonia 
mixture. 

April 24th. Better. Pain in sacral region 
almost gone, and she could walk better than 
before. Injected half a grain in the fleshy part 
of each leg. 

April 27th. No pain in back. Did a heavy 
day's washing without producing any pain in 



SCIATICA 45 



back since her last visit. This she had not 
been able to do for a long time. The only pain 
she complains of now is in her left leg from 
knee to ankle joint. Injected half a grain above 
the knee. The pain disappeared at once. With 
the same internal treatment, and an occasional 
injection, she continued to do well. 

Case vi. — E.; aged 35 ; came under observa- 
tion June 20th, 1887, when he gave the follow- 
'ng history : Pain along both sciatic nerves 
during the last three years. The attacks of 
pain come on simultaneously in both nerves, 
although the left leg is the worst. Some loss 
of motor power in this leg. Has had malaria 
and rheumatism, some burning in soles of feet. 
Injected half a grain of theine in each buttock 
over the course of the sciatic nerves. Internally, 
gave him the quinine and ammonia and soda 
salicylate mixtures, in alternation every three 
hours. 

June 2 1 St. Pain better last night than it has 
been for a long time. Slept well, which he had 



46 SCIATICA 



not done for several nights. Gave him two 
more injections in same regions, and continued 
same internal treatment. The pain at no time 
became bad again, and in less than a month of 
the treatment outlined above he ' was entirely 
free from pain, could sleep well, had regained 
the want of power in his left leg, and he was 
able to resume his vocation. 

The following three cases were reported to 
me by Dr. H. C. Fegley, of Ashland, Pennsyl- 
vania, who writes : — 

" Since your article on the action of theine 
was published, I have had the opportunity of 
testing its analgesic effects in three very aggra- 
vated cases of sciatica. In two cases complete 
recovery, with the exception of slight stiffness 
of the leg in one, took place. The third was 
an aggravated case of three years' standing, and, 
although not cured, was so much benefited that 
she is able to attend to her household duties." 

Case vii. — S. ; December 20th, 1885 ; had 
been unable to leave her chair, in which I found 



SCIATICA 47 



her, for two weeks, the least movement causing 
the utmost agony in the whole left leg. When 
perfectly quiet, no pain was felt except occa- 
sional sharp twinges shooting down to the 
foot. I put her to bed and injected a quarter 
of a grain of Merck's theine into the thigh about 
the seat of greatest pain. The injection caused 
intense burning, which lasted about three 
minutes, when she said it had left her and that 
movement in her limb caused less pain. The 
following evening I injected half a grain ; and 
repeated the dose a day after, when she felt, as 
she expressed it, entirely cured. 

Case VIII. — H. ; January loth, 1886; com- 
plained of intense, deep-seated pain in the leg, 
which had been coming on gradually for nearly 
a week. She never had sciatica before, and 
two injections, of three-quarters of a grain each, 
relieved her entirely. 

Case ix. — Mrs. A. ; has been a sufferer for 
nearly three years, and has tried a great many 
remedies, with little or no benefit. Theine in 



SCIATICA 



doses of a fifth of a grain relieved her only for 
three or four hours, but three-quarter grain doses 
gave her a full night's rest. The intense sciatic 
pain, she says, has passed away, but there are 
still some soreness and considerable stiffness in 
the limb. 

Dr. S. reports his own case to me under date 
of December 21st, 1885, in the following lan- 
guage :— 

Case x. — '' Dear Sir : I have just this day 
read your article on the * Therapeutic Action of 
Theine, ' and would say that my own case is 
almost a fac-siinile of your case Mrs. A. A. 
(which was a case of sciatica). I have tried 
every remedy I could think of, but have found 
nothing to give relief but injections of morphine. 
1 had to give up the morphine on account of the 
constitutional effect which it brought on. My 
trouble was caused by being thrown from my 
cutter about a year ago, but had no severe 
pain until last August, when I became a 
subject of severe blood-poisoning, contracted 



SCIATICA 49 



during an operation, and from which time the 
pain in my hmb began to be terrible. I went 
to the springs (Saratoga) and continued treat- 
ment for the poison. I feel so badly now that 
I find it impossible to write you in full. If you 
will be kind enough to send me some theine, 
with instructions how to use it, I will test it and 
have my case carefully reported to you. I 
would further state, that I returned from the 
springs about three weeks ago, but received no 
benefit. I am now, and have been, in bed for 
the past ten days, and I only hope that this new 
remedy will give me some relief from the most 
terrible pain possible to endure." 

Under date of March 22d, 1886, Dr. S. states : 
"In relation to the theine, I will say that it has 
done its work for me. The first injection was 
made on December 25th, one-third of a grain 
in the morning, and one-third of a grain more 
in the evening. Then I followed this up with 
daily two-third grain doses for six days, then 
two doses of the same amount for the next three 



50 SCIATICA 



days, then two doses in five days, and the last 
one in six days afterward. After this I was free 
from pain. My leg, which was three inches 
smaller than the opposite one, is now about its 
natural size. I am a thousand times your debtor 
for the theine you sent me, for I have full confi- 
dence that it gave me relief ; and, so far as my 
sciatica is concerned, it made a cure without 
any bad effects." 

Dr. Washington H. Baker, of Philadelphia, 
reports the following case : — 

Case xi. — L. N. W. ; aged 36 ; consulted me, 
Dec. 13th, 1885, on account of pain in his 
left hip, from which he had been suffering for 
eight months. Never had any disease of the 
genitalia. Has not had chills and fever, nor 
rheumatism. Had an attack of typhoid fever 
thirteen years ago, and been well ever since 
until the present trouble appeared. The greatest 
pain complained of is in the left hip, a little 
above the trochanter major; the pain also radi- 
ates around in front and down back of thigh. 



SCIATICA 51 



The pain does not extend below the knee at 
present. Some time ago it extended to ankle 
joint. Tongue clean ; bowels regular ; appe- 
tite good. Is compelled to use a cane, and 
limps when walking. 

Dec. i6th. Gave a subcutaneous injection of 
twenty minims of a two per cent, solution of 
theine. He felt better at once and could stand 
straighter. In a few minutes had a tingling 
sensation. Can walk more erect and with less 
pain. The thigh feels numb when touched, the 
leg less so. Half an hour after the injection the 
thigh still felt numb, but he could not walk 
quite so well. Was given five grains of iodide 
of potassium thrice daily. The injection was 
given about three inches above the seat of 
pain. 

17th. Injected twenty minims of theine. 
Helped him some, but not a great deal. Ap- 
plied a thapsia plaster to thigh. 

1 8th. Less pain since yesterday. Injected 
twenty-five minims of same solution of theine. 



52 SCIATICA 



19th. Walked down town to office this morn- 
ing, a distance of twenty squares. Is feeling 
much better. Injected thirty minims of same 
solution. 

2 1 St. Feels better than he has yet. Injected 
twenty-five minims. 

24th. Yesterday morning the pain returned 
in the limb. Last night it was just as bad as 
ever. Injected twenty minims, and after three 
minutes the pain began to grow less. 

25th. Still considerable pain. Injected twenty- 
five minims. 

26th. Had severe pain last night. Injected 
twenty-five minims. 

28th. Still considerable pain. I gave him a 
pill of cinch, sulph., ext. nucis vomicae, ext. 
belladonnae and pil. ferri carb. 

Jan. 6th. Better. Injected twenty-five min- 
ims of theine. 

30th. Walked into office to-day, erect, very 
little pain, and only a slight limp. Considers 
himself cured. 



SCIATICA 



The following case was reported by Dr. C. 
H. Castle, of Cincinnati, Ohio : — 

Case xii. — Neuralgia of the sciatic nerve . 
chloroform, ether, etc., had failed as curative 
remedies, or even to relieve pain. Temporary 
relief was being sought in morphia. 

4.05, Injected one-third grain of theine over 
the course of the sciatic nerve near its emergence 
from the pelvis. 

4.10. Feels easier below seat of injection. Still 
tenderness on pressure over the nerve. 

4.20. Still somewhat better. 

4.25. Jerking sensation when walking, no 
pain when lying in bed. 

4.35. Tingling sensation in heel ; walks much 
better. 

5.00. Numbness from knee down to foot ; 
warm flashes. 

5.30. Same feeling as at 5 p.m., with pain in 
hip. 

6.00. Pain not so severe in hip ; numbness 
from knee down. 



54 SCIATICA 



6.30. Complains of foot feeling very cold. It 
communicates this sensation to the hand. 

7.00. No pain, but still a sensation of cold. 
Hot sand bags applied. Next morning pain 
had returned. 

The two following cases were reported to me 
by Dr. George S. Gove, of Whitefield, N. H.:— 

Case xiii. — Injury to hip joint, of one and 
a half years' standing. The theine was used 
at first in small and afterward in large doses 
without any benefit, either alone or combined 
with morphine and atropine. Nor had mor- 
phine or atropine, combined or alone, any 
influence on the pain. 

Case xiv. — Patient aged forty-five ; em- 
ployed in a creamery ; has had rheumatism ; 
brought on a pain in his back by lifting a heavy 
milk can ; worked all that day ; had a restless 
night following ; next day was quite lame and 
stiff; worked that day, but was used up by night 
time. During the night of the third day he 
had very little sleep on account of the severe 



SCIATICA 55 



pain. Liniments and hot fomentations were 
applied without effect. When I saw him next 
niorning the pain was so great that in trying 
to dress himself he fainted and fell to the floor. 
I gave him one-half grain of theine hypoder- 
matically, about ten inches above the hip joint, 
and waited half an hour without affording much 
relief. I then gave him another half-grain in- 
jection, and the pain lessened. After a short 
time the pain entirely disappeared and has not 
returned since. 

The following case was reported to me by Dr. 
J. L. Seibert, of Bellefonte, Pa. : — 

Case xv. — "On the 15th of September, 

1886, I gave my patient, Mrs. L , who was 

suffering intense sciatic pain, a superficial in- 
jection of twenty drops of theine solution, a 
little posterior to and above the trochanter 
major. She complained of considerable burn- 
ing, which, however, lasted only a few mo- 
ments, and in twenty minutes all pain had left 
her. At 12.30 a.m. (i6th) the pain had re- 



56 SCIATICA 



turned ; I was called, and gave her -^^ gJ'^in of 
morphine and jIq grain atropine hypodermati- 
cally ; this gave her some ease, but she was not 
free from pain, and spent the remainder of the 
night without sleep. At 6 a.m. (same day, i6th) 
I again injected twenty drops of theine solu- 
tion, which in twenty-five minutes was followed 
by complete relief from pain ; and again, at 
9.30 A.M. (same day), when pain was returning, 
though not severe, I gave her ten drops more 
of theine solution, which relieved her entirely 
of all pain for remainder of day. At 8.15 p.m. 
I again visited her, and found her without pain, 
resting very comfortably, when she said that 
this was the first day she spent without pain for 
a week ; but fearing a return of the pain during 
the night, I gave her, at this visit, eight drops 
m:ore of the theine solution. At my visit at 9 
A.M., 17th inst., found her resting comfortably ; 
no pain ; had slept well all night ; this morning 
her nurse moved her to opposite side of bed 
without hurting her or giving any pain. Ex- 



SCIATICA 57 



amination of limb showed some little tenderness 
on pressure over course of sciatic nerve — gave 
her five drops of theine solution. Saw her 
again at 7.15 p.m. (same day), when, for the first 
time in two weeks, her limb had been laid out 
straight alongside of its fellow — no pain now, 
but complains of some loss of sensation in both 
legs, though she can now move limbs herself. 
This good condition lasted for three days and 
nights, when the pain again set in, apparently 
more severe than any time before, and then 
theine in forty-drop doses subcutaneously gave 
her no relief, and I was obliged to resort to mor- 
phine, which quieted her again. This condi- 
tion continued one week, when I stopped the 
use of morphine, and since which time all pain 
is again controlled by from ten to twenty drops 
of theine solution, which she gets from one to 
three times in two days. She is now conva- 
lescing. 

"All injections were made in region of left 
hip (seat of trouble), and so thoroughly did 



58 INTERCOSTAL 



theine deaden sensibility in this vicinity that the 
hypodermatic needle was introduced without the 
knowledge of the patient." 

Case xvi. — January 7th, 1886; case of 
double sciatica of fourteen years' duration in a 
gentleman sixty-five years old. Theine injec- 
tions relieve the pain, but are powerless to cure 
the degeneration which had probably taken 
place in the nerves. 

INTERCOSTAL NEURALGIA. 

Case xvii. — B. D. ; aged sixteen ; December 
31st, 1885; complained of constant pain in right 
chest, which began about three or four months 
previously. She coughed and had a yellow 
expectoration ; her appetite was variable, and 
she had nausea, and a disgust for fatty food ; 
felt chilly and hot occasionally, but her heart 
and lungs were normal. It was found that she 
had tender spots along the spine, and pressure 
there increased the pain in the right side of the 
chest. She was placed on tonic treatment, and 
on the fifth of the following month she returned 



NEURALGIA 59 



and reported herself no better. Theine injec- 
tion in the back relieved the pain at once. At 
this visit she also received the quinine and 
ammonia mixture. She failed to present her- 
self again. 

Case xviii. — H. H. ; aged sixty-four; was 
first seen March 25th, 1886, when he had pain 
in chest ; cough and copious expectoration ; no 
haemoptysis; malaria and rheumatism. Is 
addicted to the use of alcohol, and gives evi- 
dence of general bronchitis. Pressure along 
left side of the spine in interscapular region 
intensifies the pain in front of the chest. In- 
jected half a grain of theine between shoulder 
blades, left side. April ist: Better. Pain nearly 
all gone. Gave him another theine injection 
and prescribed a mixture for his cough. 

Case XIX. — H. C. ; aged thirty ; on April 22d, 
1886, applied for relief of a severe pain at base 
of his right chest, which was aggravated by 
a deep inspiration. Had some cough and 
expectoration ; was losing flesh ; felt bad, but 



6o INTERCOSTAL NEURALGIA 

never had malaria, rheumatism or syphihs. 
Lungs and heart normal. Tender spots along 
right side of spine. Injected one-half grain of 
theine over latter area. April 24th : Pain 
entirely gone. Also prescribed the quinine and 
ammonia mixture. 

Case xx. — May ist, 1886, L. M. ; aged fifty; 
complained of constant pain in the cardiac 
region, as well as of dyspnoea, and of some pal- 
pitation of the heart. Coughed, and had a yel- 
low expectoration. Heart and lungs normal. 
Injected one-half grain of theine along left side 
of spine at junction of fifth rib. May 4th : 
Pain in region of heart much better. May nth : 
Improved. Also gave him the quinine and 
ammonia mixture. 

Case xxi. — J. S.; aged twenty-four; was first 
seen April 14th, 1887, when he had an ill- de- 
fined pain in the left side of his chest — above 
and in the cardiac area ; had some dyspnoea 
and palpitation of the heart and also had 
malaria and rheumatism. Heart and lungs 



DORSAL OR INTERSCAPULAR NEURALGIA 6l 

normal. Injected one-half grain of theine in 
left interscapular region. April 15th: Pain 
was entirely relieved ; gave him another injec- 
tion. April 20th : Still improving. Another 
injection over anterior seat of pain. Also pre- 
scribed quinine and ammonia, and with an occa- 
sional injection afterward, he became well. 

Case xxii. — Mr. B.; aged thirty; was entirely 
relieved of intercostal neuralgia, accompanied 
by a peculiar constant burning pain in the left 
interscapular space, by one injection, which was 
given over painful spot along left side of spine. 

dorsal or interscapular neuralgia. 

Case xxiii. — M. C. ; aged thirty. Pain only 
between shoulder blades, at which point there 
is a feeling as if she were in constant contact 
with *' a lump of ice." Injected one-half grain 
of theine over affected spot, and gave her the 
quinine and ammonia mixture. She began to 
improve at once, and the cold feeling did not 
return as long as she was under observation. 



62 CERVICO-BRACHIAL 

Case xxiv. — On the 27th day of April, 1886, 
E. complained of interscapular pain, which was 
relieved at once by the injection of one-half 
grain of theine. 

CERVICO-BRACHIAL NEURALGIA. 

Case xxv. — H. K. ; aged nineteen ; was first 
seen February 9th, 1886, when she suffered with 
intermittent pain in right shoulder and in arm 
along the ulnar nerve. Injected one-half grain 
of theine at base of neck, and internally gave 
her the quinine and ammonia mixture. April 8th: 
No return of pain and feels good. 

Case xxvi. — Dec. 17th, 1885, Mrs. M.; aged 
fifty ; suffering from cervico-brachial neuralgia 
on right side since the previous August. Two 
injections of half a grain each, a week apart, 
were sufficient to relieve the pain. 

The following cases were reported by Dr. 
William Hall, of Conshohocken, Pa.: — 

Case xxvii. — I have used theine in three 
cases; two of cervico-brachial and one of in- 



NEURALGIA 63 



tercostal neuralgia. The case of intercostal 
and one of cervico-brachial neuralgia were en- 
tirely relieved. In the other case theine failed, 
as did all other remedies. This last case is a 
woman, whose father died of, and whose sister is 
suffering from, a similar form of pain. I am 
well pleased with the remedy in a fair case. 

Dr. G. D. Bennett, of Newton, Kansas, re- 
ports the following case : — 

Case xxviii. — In regard to my patient treated 
with theine, I would say that Mr. G. fell from 
his wagon in the early part of November, 1885, 
and dislocated his shoulder downward into the 
axilla, and also injured the brachial plexus of 
nerves, in the fall. The injury was followed by 
some pain, which grew to such severity that 
one-half grain doses of morphine gave him but 
partial relief. Some six weeks after receiving 
the injury, and when the pain in the shoulder 
was steadily growing worse, I commenced 
using theine hypodermatically, by injecting one- 
third of a grain in the morning. The result of 



64 OCCIPITAL NEURALGIA 

the first injection was some redness and pain at 
seat of injection, and in fifteen minutes numb- 
ness of finger ends appeared, which gave way, 
in half an hour, to a condition explained by 
patient as "arm being asleep." In a short 
time, probably forty minutes, pain in shoulder 
all gone. Next day visited patient, and found 
return of pain, but not so severe as before, and 
again injected one-third of a grain, which re- 
lieved him to such an extent that he had a 
comfortable day and an easy night. This treat- 
ment, for the next twenty days, was combined 
with tonics, at the end of which time my patient 
had complete use of his arm and no pain. I 
feel that we now have a remedy which is cer- 
tainly far superior, at least was in this case, to 
morphine and cocaine, for they both had been 
tried thoroughly here. 

OCCIPITAL NEURALGIA. 

Case xxix. — O. C; aged forty-five; com- 
plained of severe pain in the region of the oc- 



RHEUMATIC NEURALGIA 65 

ciput, on April 29th, 1886. The pain was par- 
oxysmal, and appeared about every three weeks. 
Injected half a grain of theine on each side of 
head, which relieved her. May 8th. No return 
of pain. 

RHEUMATIC NEURALGIA. 

Case xxx. — Mrs. J. E.; aged fifty; consulted 
me, June loth, 1886, concerning a pain and 
swelling in right knee. She had been subject 
to rheumatism, off and on, for the last twenty 
years, but eleven months ago she fell and hurt 
her knee, since which time she limps when she 
walks. Examination shows a tender spot in 
right hip joint. Injected half a grain of theine 
there, and, internally, gave her the soda sali- 
cylic mixture. Returned on the 12th, and stated 
that the pain in the hip had disappeared, but 
the knee still pained as before. Injected half 
a grain of theine above and below the knee, 
which relieved the pain in the latter place so 
much that she could walk without limping. 



66 RHEUMATIC NEURALGIA 

June 17th. Says she has less pain than she 
had for eleven months. Gave her two more 
injections, above and below knee, and same 
internal treatment. 

August 30th. Feels good. There can be no 
doubt that, considering the age of this patient, 
as well as her predisposition to rheumatism, that 
the pain will return some time. 

Case XXXI. — April 22d, 1886, S. E.; aged fifty; 
an old rheumatic; complains of pain in left 
wrist, arm and ankle joint. Injected half a 
grain in arm and above ankle. Gave her, in- 
ternally, the sodium salicylate mixture. 

27th. Feels good. Pain in arm and joints 
gone. Continued same internal treatment. 

Case xxxii. — (Reported by Dr. Washington 
H. Baker.) March 8th, 1886, a gentleman, fifty- 
eight years old, told me that he had been suffer- 
ing for several weeks with a pain in the left 
shoulder. He supposed it was rheumatism. 
He had been kept awake the greater part of 
the last three nights, on account of the pain. 



SPINAL IRRITATION 67 

The pain was getting worse from day to day. 
I injected twenty-five minims of a two per cent, 
solution into the shoulder, with immediate relief. 
That night he slept comfortably, and has not 
had any pain in shoulder up to date (March 
20th, 1886). After the injection, a burning, 
tingling sensation was complained of at site of 
injection. The theine had no appreciable effect 
on the mental faculties. 

Case xxxiii. — Dec. 5th, 1885, V.; chronic 
rheumatic pain of left shoulder joint and whole 
arm. Pain very severe. No relief rendered 
previously by salicylates, ammonium chloride, 
iron, quinine, or potassium iodide. Half a 
grain of theine above shoulder joint made him 
comfortable at once. 

spinal irritation. 

Case xxxiii. — February 3d, 1886, W.; aged 
thirty. This was a most aggravated case of 
neuralgia of both lumbo-sacral and left cervico- 
brachial plexuses, associated with irritability of 
the spine along its whole course. The pain had 



68 SPINAL IRRITATION 

been coming on for two months or more. It 
was intermittent, very intense, and accompanied 
by muscular contractions of both legs below 
the knee, and left forearm. It was impossible 
for the patient to stand erect when he suffered 
from the pain — in fact, he was confined to his 
bed most of the time. Four injections, of one- 
sixth grain each, in the evening, made him 
comfortable during the night and next day 
until evening, while with other remedies, like 
potassium iodide, iron, ammonium chloride, 
quinine, phosphoric acid, strychnine and cod- 
liver oil, have been kept up for nearly three 
weeks, and now (March ist) the patient is in a 
good condition, able to walk twenty-five squares 
in one stretch, and only requires an occasional 
injection. The injections were all made on 
each side of the spine, in the interscapular and 
lumbo-sacral region, and never failed to give 
him instantaneous relief, no matter how severe 
the pain was at the time. 



NEURASTHENIA 69 



NEURASTHENIA. 

Case xxxiv.— (Reported by Dr. H. Wod- 
drop, Loag, Pennsylvania.) M. ; married ; aged 
forty ; was found, last December 4th, with con- 
siderable pain, of intermittent character, in left 
leg. For a month previous he had been suffer- 
ing with occasional twitches of pain, and was 
now confined to his couch. He also had stiff- 
ness as well as oedema in his other limb. He 
was treated with morphine (by the mouth and 
subcutaneously), ammonium chloride, quinine, 
iron, strychnine, and arsenic, until the last of 
December, when the swelling had entirely dis- 
appeared, but there were considerable pain and 
stiffness left in the limbs. About this time I 
saw your article on theine, procured some, and 
injected one- fifth of a grain deep into the calf 
of the left leg. This caused some pain, and 
succeeding symptoms were very near your de- 
scription. Continued internal treatment and 
subcutaneous injection of theine occasionally. 
On January 19th changed internal treatment 



70 OTHER PAINFUL DISEASES 

to small doses of phosphorus, beef peptonoids 
and milk. On January 23d could move his 
limbs freely, had no pain, and appeared, ex- 
cepting debility, a well man. He received, in 
all, twenty-four injections, sometimes twice a 
day. I attribute his recovery, in great part, to 
theine, but the constitutional treatment was 
also very important. I have no doubt that, by 
the use of theine, I shortened the case materi- 
ally. The burning which was occasioned by 
the injections lasted about fifteen minutes, after 
which the pain in the limbs ceased. The pain 
returned at varying periods, not as severe after 
the injections as before, and it always subsided 
directly after the use of theine. I believe theine 
to be a perfect analgesic, and have noticed no 
narcotic effects from its employment. 

THEINE IN THE TREATMENT OF OTHER PAIN- 
FUL DISEASES. 

I think sufficient evidence has now been ad- 
duced to show the usefulness of theine in pure 
and uncomplicated nerve pain, or in diseases in 



OTHER PAINFUL DISEASES 7 1 

which the pain is strictly hmited to the sensory 
nerves. In the succeeding pages, proof will be 
offered to show that it is also a true analgesic in 
those kinds of pain which are not supposed to 
be absolutely confined to nerve tissue, viz. : 
muscle pain. On the whole, it may be said, how- 
ever, that the distinction between nerve and 
muscle pain is more artificial than genuine. 
Although the organs of sensation and of motion 
are intimately associated, and are both evolved 
out of the same fundamental tissue, practically, 
there can be no sensation or pain independent 
of nerve tissue. Hence, while it is true that in 
myalgia there is a diffusion of pain rather than 
localized spots of pain along the trunk of a 
nerve, as in neuralgia ; that the pain of myalgia 
is more aggravated by movement than that of 
neuralgia ; and while it is true that there are 
other clinical differences between the two affec- 
tions, there is reason for believing that the pain 
of myalgia is as truly nervous as that of 
neuralgia. 



72 MYALGIA 



Below will be presented the histories of some 
cases of myalgia and of lumbago, as well as of 
other non-neuralgic diseases, in which theine 
yielded as good service as it did in those of 
neuralgia. 

MYALGIA. 

Case xxxv.— (Reported by Dr. Castle, of 
Cincinnati, Ohio) Myalgia of the deltoid 
muscle. Pain severe. Had had one-quarter 
grain of morphine every two hours the night 
before, without bringing sleep. Could not raise 
arm. 

9 p. M. One-sixth grain of theine subcu- 
taneously about the anterior margin of the 
trapezius, just above the shoulder ; pulse, 102. 

9.04. Very little pain, unless she moved her 
arm. Still marked tenderness on pressure. 

9.05. Pulse 96. Diminished sensibility about 
seat of injection. 

9.10. Seat of pain seemed to be only in lower 
half of its former area. 



MYALGIA 73 



9.13. Numb feeling in arm as far down as 
elbow. Very little pain on moving arm. 

9.15. Can now bear pressure over former 
exquisitely tender spot. 

9.20. Pulse 96. Only tenderness is now over 
acromion. No pain at all on pressure over 
anterior part of arm. 

9.30. Numbness not so marked. Says, if only 
had as much pain as she now has, she could 
easily bear it. 

9.37. Pain now only about insertion. 

9.40. Numbness in arm diminishing, but pain 
not increasing. Says she could go to sleep. 

11.00. Pain, has returned, but in a much less 
degree. Needs no morphine. 

Since then has not complained. 

Case xxxvi. — April 7th, 1886. M. G., aged 
32, suffered from severe pain in and below left 
shoulder joint. Injected half a grain of theine, 
which relieved him before he left the office. 
Never saw him again. 



74 LUMBA.GO 



LUMBAGO. 

Case xxxvit. — March 25th, 1886. D. O.; 
aged 44 ; laborer ; complained of severe pain in 
back, which was almost exclusively confined to 
the lumbar region. Cannot bend body, or sit 
down without a great deal of pain. Walks 
very stiffly. These attacks occur periodically. 
Injected one-third of a grain of theine on each 
side of the sacrum, and in a few minutes he 
was able to stoop, and sit down without any 
inconvenience. He expressed himself as being 
well pleased. 

Case xxxviii. — April 29th, 1886. G. T.; aged 
33 ; laborer ; suffers from pain and weakness in 
the lumbar muscles. Injected half a grain of 
theine on each side of painful region. 

May 8th. Less pain since injection. Injected 
another half- grain. 

Oct. 9th. No pain in back since last injec- 
tion. 

Case xxxix. — March 30th, 1886. S. M.; aged 
45. Has had fever and ague and complains of 



LUMBAGO 7 5 



pain in the lumbar region. She says, " The 
pain catches me in the back when I rise." 
Gave her quinine and iron. 

April 1st. Pain in back very severe. She now 
received half a grain of theine over painful 
spot, and she felt better at once. Same internal 
treatment. 

April 17th. No return of pain. 

Case xl. — (The two following cases were 
reported to me by Dr. Baker.) J. B. came to 
me in December, 1885, complaining of a severe 
pain in the lumbar region, which almost inca- 
pacitated him for work. Injected twenty-five 
minims of a two per cent, solution of theine in 
lumbar region above painful part. He was 
relieved at once, and has not been troubled 
with it since. 

Case xli. — J. R. W.; aged thirty years ; brake- 
man ; suffered from pain in the lumbar region, 
which troubled him, particularly when he bent 
over to wash his hands. I injected twelve 
minims of a two per cent, solution of theine 



^6 MUSCULO-RHEUMATIC PAIN 

under the skin above the painful spot, with 
immediate and entire rehef of pain. It was 
really ludicrous to see the astonished expres- 
sion on his countenance, and the contortions 
he went through to assure himself that he was, 
in truth, relieved. I also gave him two and a 
half grains of potassium iodide thrice daily. 

Dec. 22d. Injected twenty-five minims of 
theine, as there was a suspicion of pain in the 
back. This visit was one week after the first. 

Jan. 1 2th, 1886. Reports no trouble with his 
back. 

MUSCULO-RHEUMATIC PAIN. 

Case xlii. — (Reported by Dr. Castle.) The 
patient was the subject of those ill defined' 
dragging, musculo-rheumatic pains of the 
extremities, found not infrequently in such a 
damp climate as is ours. About one year ago 
he had obtained marked relief from an electric 
bath, taken in Chicago, and at the time I 
encountered him he was on a search for a 
similar electropathic institution in Cincinnati. 



PAIN OF LOCOMOTOR ATAXIA "J^ 

I persuaded him to allow me to use one-sixth of 
a grain of theine upon him hypodermically. The 
pain was severe in the anterior muscular masses 
of both thighs and in the calves of both legs. 
I made my injection slightly below the popliteal 
space, and toward the inner side of the leg. 
The effect was striking and almost instanta- 
neous. The point of injection, though angry- 
looking, was quite ansesthetic, and as little 
tinghngs shot down the leg toward the foot, the 
pain vanished and the analgesia of the in- 
jected leg was in marked contrast to the pain 
in the thigh of the same extremity and the 
thigh and leg of the opposite extremity. This 
beneficial effect was maintained for a few days, 
at which time I last saw the patient, and I 
exceedingly regret that we have neither of us 
had the time or opportunity to relieve the still 
suffering fragments of his body of their aches. 

PAIN OF LOCOMOTOR ATAXIA. 

Case xliii.— April 4th, 1886. J. P.; aged 50. 
Suffering for three years from locomotor ataxia. 



y2> PAIN OF 

Has been unable to walk or move his arms for 
three months, and on account of the pain in 
the back, arms and legs he is compelled to pass 
days and nights without sleep. Has well- 
marked constriction around the base of his 
chest and suffers from oedema and spasmodic 
contractions of both extremities. This patient 
received two and a half grains of theine every 
other day, in different spots along the spine, with 
the effect of giving him relief to his pain. This 
course was pursued for about four months, and 
while it did not ameliorate his general condi- 
tion, it gave him sleep, relieved the pain and 
contractions in the back and extremities, 
removed the thoracic constriction, and, on the 
whole, it made the patient feel more comfort- 
able than he was before. 

It is but fair to state here that, in another case 
of locomotor ataxia, the theine injections sig- 
nally failed to relieve the pain. This patient 
was, however, addicted to the protracted use of 
large doses of morphine, and the pain of which 



LOCOMOTOR ATAXIA 79 

he complained was chiefly referred to the 
stomach, and, no doubt, partook of the nature 
of opium pain. This was promptly relieved by 
the subcutaneous administration of morphine. 



APPENDIX. 



Dr. Charles K. Mills, President of the Phila- 
delphia Neurological Society, made the following 
remarks on a paper entitled " Theine in Pain," which 
I had the pleasure of reading before that Society, De- 
cember 19th, 1887 [copied irova Jozirnal of Nervous 
Diseases^ January, 1888] : — 

"A few months ago I began the use of theine, or- 
dering it in nearly every case of neuralgia, superficial 
neuritis or lumbago that came to the Polyclinic service, 
and also using it at the Philadelphia Hospital. I 
have used the drug probably in about fifteen cases, 
but I have not had time to prepare notes of them for 
this meeting. I recall three cases of sciatica, two of 
which were of long standing. These cases were all 
m proved, but none of them were cured, by the use 
of theine alone. The pain was usually much relieved 
by the hypodermatic use of theine, but it would re- 
turn after a shorter or a longer time. In connection 
with the theine, I used galvanism to the nerve and 
muscles, and internally Donovan's solution, or iodide 
of potassium. Two of the cases of sciatica were 
cured under this conjoint treatment. 
81 



82 APPENDIX 



*' In a case of facial neuralgia, or neuritis, I used a 
hypodermic of theine in the face ; following this, the 
patient became pale, sick at the stomach, and seemed 
to be in a slightly dazed condition for a time. Whether 
this was due to the drug or simply to the slight oper- 
ation, I cannot say. The injection entirely relieved 
the pain for three days. The patient then returned, 
and another injection was given, without bad effect. 
In another facial case the patient was certainly re- 
lieved by theine, and, so far as I know, remained 
well. 

" I have used it in the back with great benefit in 
so-called myalgia, including under that term muscular 
rheumatism, and possibly true lumbar neuralgia. 

" I believe that theine is an analgesic ; that it re- 
lieves pain in cases of recent and superficial neuritis, 
or neuralgia. In chronic, painful nerve troubles, par- 
ticularly where the nerves are deeply situated, it seems 
to be simply a helping remedy, and sometimes fails." 



INDEX. 



A CTION. differential, between morphine and theine, 34, 
-^^ Action, differential, between theine and caffeine, 16. 
Action of theine confined below seat of injection, 35. 
Adjuvant treatment, 40. 

"D AKER, Dr. W. H., experience with theine, 50. 
^ Bennett, Dr. G. D., experience with theine, 63. 
Botanical origin of theine, 9. 

/^^ASTLE, Dr. C. H., experiments with theine, 21. 
^-^ Cerebral intoxication of theine, 25. 
Cervico-brachial neural2:ia, 62. 
Coffee and tea, gross effects of, 13. 
Coffee more powerful than tea, 14. 
Crucial differential test, 16. 

"T^EEP injections of theine not necessary, 29. 

-*-^ Dissimilarity of effects of theine and caffeine, 15. 

Dorsal or interscapular neuralgia, 61. 

Dose of theine, 30. 

TZTEELIXG of coldness produced by theine, 21. 
-*- Fegley, Dr. H. C, experience with theine, 46. 

Formula for hypodermatic use, 32. 

/^"'OVE, Dr. Geo. S., expeiience with theine, 54. 

■jLJ ARRIS, Wm., manufactured theine and caffeine for 
-'■ -*■ author. 12. 

IDENTITY, supposed, of theine and caffeine, 13. 

-*• Importance of removing diathesis on which pain depends, 

33- 
Intercostal neuralgia, 58. 
Iodide of potassium in sciatica, 51. 

" " " lumbago, 76. 

Irritation produced by hypodermatic injection of theine not 
prolonged, 31. 

T ETHAL dose of theine larger than of caffeine, 15. 
-'-^ Local action of theine, 34. 

Lumbago, 74. 

83 



84 INDEX 



A/TERCK'S theme reliable, 33. 

^^^ Mills, Dr. Chas. K., experience with theine, 81. 

Morphine, general action of, 34. 

Musculo-rheumatic pain, 76. 

Myalgia, 72. 

TVJEURALGIA, definition of, 37. 
-'-^ " varieties of, 38. 

Neurasthenia, 69. 
Neuritis, 82. 

QCCI PIT AL neuralgia, 64. 

^-^ Opium pains, 79. 

Origin and nature of neuralgia, 39. 

■pAINFUL diseases, theine in, 70. 

^ Pain of locomotor ataxia, 77. 

Physiological diflference between theine and caffeine, 15. 

Physiological test for theine, 16. 

Prompt action of theine, 30. 

"p EDUCTION of pulse by theine, 20. 
-*^ Rheumatic neuralgia, 65. 

CCIATICA, 39. 

*^ Seibert, Dr. J. L., experience with theine, 55. 

S , Dr., experience with theme, 48. 

Sensory paralysis produced by theine, 17. 
Spinal irritation, theine in, 67. 

'T^ABLETS of theine for hypodermatic use, 32. 
-*• Tea as a beverage, 9. 
Tea, botanical origin of, 9. 
Temperature, influence of theine on, 21-23. 
Theine in pain of locomotor ataxia, 77. 
Theine, its chemical form.ula, 10. 

** " solubility in water, 10. 

" " indiscriminate manufacture, 11. 

" " function is only as a pain reliever, 33. 

T TNRELIABILITY of ordinary commercial theine, 32. 
VyODDROP, Dr. H., experience with theine, 69. 



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